FINALLY — the truth comes out on a major news network (NPR): a so-called “serotonin imbalance” in the brain has never been scientifically linked with depression, and this false theory was used for years to sell SSRIs (selective serotonin reuptake inhibitors – modern antidepressants) to a lot of people out there as a scientifically proven, biological cure to their biopsychiatric problems. Meanwhile, news of the appalling “side” effects of the drugs (suicidal and homicidal ideation in at the very least 5% of patients) was squelched, and literally thousands of people lost their lives in SSRI-related suicides and homicides.

After hearing all this, one would assume that we were done with that whole “chemical-imbalance-in-the-brain-causes-depression” thing. We have established that the theory is false. It’s a dead (and deathly) issue. Right?

And the biopsychiatric idea that a chemical imbalance of some kind MUST cause depression – and that ameliorating this chemically/pharmaceutically must therefore CURE depression – is alive and well. In only a week’s time, NPR has managed to resurrect it. You see, it wanted to live. Or at the very least, pharma wants it to.

Zarate [a “research scientist”] sees depression as a bit like a leaky faucet in the brain. There are different ways to stop the leak, he says. “You can go straight to the faucet and you can fix it,” he says. “Or you can go to the water plant and shut down the water plant. The end result will be the same.”

The current antidepressants act in a way that is like shutting down the water plant, Zarate says. It takes a long time for the water to stop flowing through the miles of pipes that eventually lead to the leaky faucet.

He thinks the reason is that these drugs act primarily on the brain chemicals serotonin, norepinephrine and dopamine. Ketamine acts on a chemical called glutamate, which is much closer to the problem, Zarate says.

So let me get this straight:

Last week we learned that a serotonin imbalance in the brain does not cause depression. Scientists were confused on this point for some unspecified length of time because Prozac, a miracle/blockbuster drug that somehow “cures” depression, raises serotonin levels in the brain. Scientists understandably put two and two together and assumed that higher serotonin levels = no depression because Prozac presumably also = no depression. (Never mind that Prozac and other SSRIs have since been proven to be no better than placebo).

At some point, scientists figured out their theory was incorrect, or at best oversimplified to the point of being false [a distinction they insist on making!], but they continued to present it to patients as fact “for the patients’ own good” so the patients would take their meds. Which scientists still insisted “worked” to “cure” depression. (Again, no better than placebo.)

One week later, in the next installment of the series, we learn two things:

1. NPR has changed the story about serotonin – now it does work to cure depression by addressing problems in brain chemistry. [Never mind what they said last week!]

Traditional antidepressants like Prozac work on a group of chemical messengers in the brain called the serotonin system. Researchers once thought that a lack of serotonin was the cause of depression, and that these drugs worked simply by boosting serotonin levels.

Recent research suggests a more complicated explanation. Serotonin drugs work by stimulating the birth of new neurons, which eventually form new connections in the brain. But creating new neurons takes time — a few weeks, at least — which is thought to explain the delay in responding to antidepressant medications.

2. This new drug – ketamine – works, too, but it works BETTER and FASTER!

Ketamine, in contrast, activates a different chemical system in the brain — the glutamate system. Researcher Ron Duman at Yale thinks ketamine rapidly increases the communication among existing neurons by creating new connections. This is a quicker process than waiting for new neurons to form and accomplishes the same goal of enhancing brain circuit activity.

I need hardly add that the author of this story did not cite any of the research studies referred to above. He did, however, include these pretty pictures which successfully distracted my attention from the lack of documentation for his outrageous claims by looking so very “scientific” and “official.”

Look at the pretty pseudoscience!

Just kidding. I’d like to see proof, not pictures.

Hope

The story’s headline promises to give us hope. Here is what the author has to offer, at the close:

The goal of the NIH [National Institutes of Health] experiments with ketamine, riluzole and scopolamine is to identify compounds that pharmaceutical companies can use as molecular models to develop an entirely new class of antidepressants… Drug companies have taken notice. Several are now working on glutamate drugs for depression.

I guess we’re supposed to hope that pharma can patent this new chemical and sell it using a recycling of the old SSRI pitch? (As NPR has already begun to do for them…)

Are we supposed to hope that drug companies will conduct fair research trials on this new class of antidepressants, that they will accurately report the results of these trials, that they will be ethical in addressing concerns about adverse drug events in or out of court?

Let me try that on for size….

Nope. I don’t feel hopeful. Not in the least bit.

I’d rather hope for something else.

I hope I never again have to hear another repetition of this ridiculous, thousand-fold lie about mere “chemical imbalances” being the cause of this thing we call “depression.” (Or any “mental illness,” for that matter.)

I hope that people dealing with depression will be allowed to make their own, fullyinformed choices about treatment.

I hope that their family members and friends will be their cheerleaders and confidants, and they will find wholesome and healthy ways to address the root causes that their depression arises from.

Because depression is not merely “of the body,” a simple biological imbalance and nothing more. It is a mind-body phenomenon, it is subjectively real, it is connected to the world, and it is oftentimes a message about the world.

A message we should each process, understand, and integrate in our own way, in our own time.

But, as I have been delighted to learn recently, his is by no means the only iteration of this treatment model. Another pioneer in this field – a friend and contemporary of Mosher’s, in fact – was the Jungian John Weir Perry. His treatment center, called Diabasis, operated in San Francisco in the 70s. Heavily influenced by Jungian approaches to psychosis (Perry did study with him in Switzerland) and Chinese philosophy, Diabasis was a place for schizophrenics to process their internal Apocalypse with the loving support of the laypeople staffed by the project. Medication was, for the most part, avoided, as were restraints and coercion of any kind.

Today I stumbled upon an extensive and fascinating interview with John Weir Perry about the nature of psychosis and “schizophrenia” and the approach of Diabasis to these phenomena. I’ve pasted a few of my favorite excerpts below, but you can also download the entire thing here.

On Diabasis and the healing nature of a supportive, home-like environment:

One has to let the visionary process unfold itself spontaneously.

Under these conditions, to our surprise, we found that our clients got into a clear space very quickly! We had started out with the notion that we would surely be in for a lot of bedlam with all this “madness” going on, but actually the opposite was true! People would come in just a crazy as could be on the first day or two, but they’d settle down very soon into a state of coherency and clarity… The calming effect of a supportive environment is truly amazing!

Now throughout all this there was nothing scheduled, nothing mandatory. It was all informal… You see, we wanted them to be in this house of their own free will. They had to realise their own desire to belong in the house, and they did.

So this whole approach is essentially one of releasing, rather than suppression. We allowed everything and encouraged its expression — not towards chaos, but toward communication! Communication tends to order.

[emphasis added]

Schizophrenia as a self-healing process:

“Schizophrenia” is a self-healing process – one in which, specifically, the pathological complexes dissolve themselves. The whole schizophrenic turmoil is really a self-organising, healing experience. It’s like a molten state. Everything seems to be made of free energy, an inner free play of imagery through which the alienated psyche spontaneously re-organises itself – in such a way that the conscious ego is brought back into communication with the unconscious again…

It [psychosis] is like the mythological image in a perfect stained-glass window being smashed, and all the bits and pieces being scattered. The effect is very colourful, but it’s very hard to discern how the pieces belong to each other. Any attempt to make sense of it is an exercise in abstraction from the actual experience. The important thing is to find the process running through it all.

[emphasis added]

“Chronic schizophrenia” – a cultural construct:

[Interviewer:] So are you saying that the reason we have so-called “chronic schizophrenia” in our society, – where a person is medicated, distressed or hospitalized for decades – is really cultural? A society which refuses to understand the healing nature of the phenomenon?

Yes, it seems so. Of course, there are some unusual cases where the individual simply can’t handle the impact of all this unconscious content, or doesn’t know what to do with it, and freaks out. But from my experience at Diabasis, I’ve seen so many people go the other way that I really do feel “chronic schizophrenia” is created by society’s negative response to what is actually a perfectly natural and healthy process.

Goal of Perry’s treatment approach:

The tendency [amongst first break schizophrenics]… is to concretise all the symbolic stuff and believe there are enemies out there, and that the walls are wired, that there are people with guns at the window, and subversive political parties trying to do things, or that one is being watched because one is the head of some organisation and everybody knows it. All of that is a mistaken, “concretistic” tendency to take too literally things whose correct meaning is actually symbolic.

So yes, the therapeutic goal is to achieve that attitude which perceives the symbolic nature of the ideation which belongs to the inner reality. Now, the inner reality is real! It’s very important to grant it that reality, but not to get the two realities mixed up. That’s the trick! Actually, for most people it’s surprisingly easy…

The average person tends to go along with the inner journey and to realise – well, they do need to be reminded – but once they’re reminded, they tend to quickly perceive that it is a spiritual test, or a symbolic test, and not the actual end of the actual world.

If you’re intrigued by Diabasis and would like to know more, Perry wrote a book called The Far Side of Madnessabout the program. Additionally, Michael Cornwall over at Mad In America is blogging about his experience with the program. I suggest you check out what he has to say about it as well!

Psychotropic drugs are the top sellers for pharma. But cancer drugs – specifically those involved in chemotherapy – are big money makers, too. Very serious business.

You know the business model – pharma comes up with a drug to “treat” a specific condition that just happens to cause that condition. Anti-depressants cause suicidal ideation, anti-psychotics cause psychosis, mood stabilizers cause mania, anti-convulsants cause seizures.

It’s no different outside the world of mental health, folks. Cancer drugs (chemotherapy) are radioactive, carcinogenic. By their very nature, they increase the likelihood of cancerous growth. Nevertheless, (literally) poisonous and deadly cancer drugs from the 70s and 80s continue to sell like hotcakes to desperate families who are told there’s no other option, never mind the cure is in most cases far worse than the cancer itself!

A highly unethical, but nevertheless enriching business model for pharma and friends.

But what happens when an independent inventor – unassociated with any pharmaceutical company — discovers a cheaper therapy with significantly higher efficacy and virtually no side effects?

This simply cannot be allowed.

They [pharma, FDA, National Cancer Institute, etc.] do everything in their power to crush that man out of existence. And if that doesn’t work [it didn’t], then they try to steal his invention! And if that doesn’t work, well they do it all over again until sheer exhaustion sets in.

I’m talking about Dr. Stanislav Burzynski, the inventor and sole patent-holder on a set of chemicals which he calls “anti-neoplastons.” Derived from healthy human urine, the anti-neoplastons are made up of peptides and amino acids lacking in cancer patients. Astonishingly, anti-neoplaston therapy has significantly better results than chemotherapy. How much better?

Take cancer of the brainstem glioma, most commonly found in children, with a near 100% death rate. Chemotherapy has been shown to cure [cure being defined as living 5 years after diagnosis] .9% of patients. Anti-neoplastons?

Almost 25%.

Whoa.

There’s a lot more to tell, but I don’t want to spoil the film for you.

I hope you enjoy this as much as I did!

PS – for interested parties there are shorter excerpts from the film, as well as full access to all source documents available on Burzynski’s website.

The APA must have an almost supernaturally subtle sense of humor and irony – the finest and most unflinching I have ever encountered.

Or else they are so steeped in hypocrisy that even the most blatant contradictions, the most horrendous lies (cross-referenced, of course), are fervently preached as gospel truth. A pack of true believers, indeed.

There’s a spirit of unrest sweeping this country – the recent and successful PIPA/SOPA internet blackout protest, the various “Occupy” movements, the multiple student protests on college and occasionally high school campuses being a few examples. People are getting stirred up.

Well, the APA doesn’t want to be left out. Let it be known that they, too, can occupy something!

“Occupy Medicine: Reclaiming our lost leadership”

A call to arms was issued in the January edition of the APA’s journal, the Psychiatric Times. It’s hard to know whether to laugh or cry bloody tears of frustration. Let’s try to laugh, shall we?

It begins like this:

Maybe the “Occupy Wall Street” movement suggests a different kind of protest …What about “Occupy Medicine” for us psychiatrists? This may sound somewhat ridiculous, given that psychiatrists still make a good living, but we are surely in the 99% of medicine. In fact, we may be in the lower 1% for reimbursement… I’m often struck that plumbers make more per hour.

Now this article is posted right next to the “Psychiatry Compensation Survey 2011,” an annual survey regarding income and income satisfaction of APA members, on the Psychiatric Times website. The average income of these 99%-ers was neatly displayed in colorful pie graphs just inches away from Moffic’s petulant cries for protest.

[click to enlarge]

The majority of psychiatrists make over $175,000/yr, yet Moffic proudly proclaims them an oppressed part of the “99%”! Is this that subtle sense of irony again?

Oh, and plumbers do NOT make more money.

As near as I can tell (and they didn’t include much information about their survey methods, so it’s hard to say for sure) – but it appears that this survey only counts money directly obtained through practicing psychiatry. So it does NOT include any “extra” income, like money from pharmaceutical companies. You know, honoraria, “lectures,” “consulting,” “research,” etc. Considering that 1 in 4 doctors offer these kinds of “services” to pharma, adding that income would further enhance their salaries.

Nevertheless, over 40% of the psychiatrists surveyed were “disappointed” with their level of income.

Yes, psychiatrists are a downtrodden lot. Much has been taken from them. For example:

Other medical and mental health professionals have taken over our business to a great extent. Take primary care physicians, who now prescribe well over half of psychiatric medication prescriptions, despite evidence of limited expertise and success.

-Dr. Moffic

“Limited expertise and success,” eh? One could surely say the same about psychiatrists! But I digress…

Where psychiatrists are really bleeding money is in the land of diagnosis, which should, according to Moffic, be their own exclusive province.

Where we’ve really given up our product is in diagnosis. Though the APA has put out the official diagnostic manuals in the United States for decades, it opened up its use to any clinician who claimed enough expertise and knowledge. The APA makes a lot of money selling these manuals to other clinicians, who far outnumber psychiatrists, but what does this do to our role and status? …

Psychiatry is a strange kind of business. We’ve given out our products for free, then watched as other businesses—whether they be other types of clinicians or insurance companies—take over what we do… as important as what the diagnostic criteria should be, so is who is qualified to use them.

– Dr. Moffic [emphasis added]

Their “products?” But I thought the DSM was an objective, scientifically-derived set of criteria defining real, biologically-based diseases? And psychiatry a scientific discipline, not a business?

Clearly, an occupation is needed, so that psychiatrists can reclaim the [additional] wealth that is rightfullytheirs. There are some barriers, however. You see, according to Moffic “psychiatrists tend to caring and compassion,” and so they have passively allowed the oppression thus far. But Moffic remains hopeful:

Thankfully, the anti-psychiatry movement has died down. In an unexpected way, there’s more of a pro-psychiatry movement becoming embedded in our systems. These are our patient consumers and peer specialists. Could they be recruited as our advance force for Occupy Medicine? Who knows better? Most naturally our patients and their families know what the illnesses have caused them to lose and what they need to recover.

-Dr. Moffic

Oh, that’s rich.

What say ye, psychiatric survivors? Would you like to join forces with the APA in demanding that psychiatrists make more money? Let’s catapult them into the top 1%, where they belong!

Anybody? No?

Let me present an alternative

One that may be more to your liking.

In the run-up to the release of the DSM-V on May 5th, Mind Freedom International [MFI] is urging its members to “Occupy Normal.” It is a “fight to stop corporate and government sponsored brain damage, trauma and an epidemic of human suffering” by “occupying the mental health system.”

They have a number of ways you can participate listed on their website. Additionally, a large protest is planned for that fateful day – May 5th – in Philadelphia, the site of the APA conference where the DSM-V will officially be released. Lots of influential folks in the anti-psychiatry movement (which is alive and well, thank you very much Dr. Moffic!) will be there, including Robert Whitaker, author of Mad in Americaand Anatomy of an Epidemic.

Now what say ye, psychiatric survivors, peer supporters, and people who think critically about mental health in our society? Is this an occupation more to your liking?

Johnson & Johnson has come under fire recently for sundry illegal marketing practices related to the antipsychotic drug Risperdal (as enumerated here and here in legal documents, and here by a former J&J salesperson). “Recently” isn’t entirely accurate… considering that they were warned in 1994, 1999, and 2004 by the FDA to stop making “false and misleading claims” about Risperdal’s efficacy and superiority to other atypical antipsychotics, this has been a long time coming.

So let’s do the math. How much money will J&J have to pay for the privilege of doing whatever they damn well please in marketing Risperdal, a brain-damaging, diabetes-, obesity-, akathisia-, homicidal/suicidal ideation-causing, so-called “safe” antipsychotic?

$1 billion to the US and some states who have joined in the federal (civil) case against Risperdal

$257.7 million to the state of Louisiana in 2010

$327 million to South Carolina in 2011

$158 million to Texas in a settlement agreed upon last Thursday

$400 million more as a penalty for violating the “Food, Drug, and Cosmetic Act”

That would make Risperdal the most heavily fined of any single drug ever produced by pharma (incidentally, another atypical antipsychotic medication, Lilly’s Zyprexa, comes in a rather distant second at $1.4 billion).

Not too shabby. It becomes a mere line item in the marketing budget, simply a “cost of doing business.”

Never mind the human cost.

The human cost

Since they’re not going to, let’s you and I spend a moment considering the human cost.

Meet Ke’onte Cook, a 12-year-old survivor of the foster system who was wrongfully medicated with antipsychotics.

As you may recall, in November of 2011 an important study published in the journal Pediatrics found that youth in foster homes with behavioral problems were being wrongfully prescribed antipsychotics as a chemical means to ensure docility. On average they were being prescribed these drugs at twice the rate of children outside the foster system. More on that here.

The foster system population is one of the specific groups that J&J is accused of targeting with their off-label marketing practices.

Here is Ke’onte’s story about the human cost, for him, of J&J’s marketing strategies:

This is a poem written by an anonymous high school senior in Alton, IL two weeks before he committed suicide:

He Was Square Inside and Brown

He drew… the things inside that needed saying.Beautiful pictures he kept under his pillow.When he started school he brought them…To have along like a friend.It was funny about school, he sat at a square brown desk
Like all the other square brown desks… and his room
Was a square brown room like all the other rooms, tight
And close and stiff.

He hated to hold the pencil and chalk, his arms stiffHis feet flat on the floor, stiff, the teacher watchingAnd watching. She told him to wear a tie likeAll the other boys, he said he didn’t like them.She said it didn’t matter what he liked. After that the class drew.He drew all yellow. It was the way he felt aboutMorning.The Teacher came and smiled, “What’s this?Why don’t you draw something like Ken’s drawing?”After that his mother bought him a tie, and he alwaysDrew airplanes and rocketships like everyone else.He was square inside and brown and his hands were stiff.The things inside that needed saying didn’t need itAnymore, they had stopped pushing… crushed, stiffLike everything else.

They’re set up to look like academic lectures, and they have nice-sounding titles like “Positive Engagement: Therapeutic Alliance & Long-acting Therapy Given by Injection in the Treatment of Schizophrenia.” I felt really good after I read words like “positive,” “engagement,” and “therapeutic.”

It features a man by the name of Xavier Amador, Ph.D. giving a powerpoint lecture designed by Janssen.

Xavier Amador, for Janssen Pharmaceuticals

In it, he explains what is really meant by those lovely words I mentioned above.

Most fascinating is the manner in which he approaches “therapeutic.” According to Xavier, part of the problem with schizophrenics is that they don’t always agree that they’re suffering from a lifelong illness, that recovery is impossible, and that they need drugs for the rest of their lives.* They don’t know they’re sick!

There’s a special name for this in psycho-babble – it’s called anosognosia.

Here’s the key: folks who do know they’re sick (again, by the above definition), are the ones most likely to take their medications. To be compliant. And so the real role of the “psychiatrist who cares” is to therapeutically convince the patient that he is indeed sick in this manner, and that he should take his meds, preferably via injection.

Dr. Xavier Amador, funded by Janssen, has spent a good deal of his professional career hawking an evidence-based practice (he calls it “LEAP”) guaranteed to do just that.

He goes into greater detail in another presentation, also funded by Janssen, which he gave at a government-sponsored conference in New Jersey last year.

Entitled, “I am not sick, I don’t need help,” the presentation is all about anosognosia, how it “impairs common sense judgment about the need for treatment,” and how overcoming it is “one of the top predictors of long-term medication adherence.” [which he appears to equate with recovery]

Yes, it is somewhat funny that a self-proclaimed “academic” would stand – in all seriousness – in front of a slide bearing that message.

But as it turns out Amador has been standing in front of silly slides and saying equally ridiculous things for years.

Amador and anosognosia go way back

All the way back to 1997, in fact, when Amador was involved in the trial of Ted Kaczynski, also known as the “Unabomber.” Kaczynski did not want to mount a defense based on a plea of mental illness or insanity and actually went to great lengths to block his attorneys from doing so. He maintained that his actions were deliberate, a logical result of his personal philosophy as outlined in his Manifesto and extensive journals (which he stated he kept, in part, to prove that he was not “mentally ill”). Kaczynski wanted people to understand the motivations for his actions and not have them be discredited as the “ravings” of a schizophrenic – and he was willing to risk the death penalty in order to so.

Nevertheless, a court-ordered psychiatric evaluation conducted found him to be schizophrenic (full text available here – also by court order, so that the public might gain a “better understanding of the Unabomber’s [schizophrenic] motivations”).

That he was found to be schizophrenic really comes as no surprise. As one of my favorite studies shows, even people displaying no psychiatric symptoms whatsoever have little trouble obtaining that label.

And what were Kaczynski’s symptoms? His “lack of personal relationships,” his “delusional thinking involving being controlled by modern technology,” and (drumroll, please) anosognosia.

Amador, who served as an independent expert for the court, reviewed Kaczyinski’s extensive psychiatric records, neuropsychological test results, and the infamous unabomber diaries. Amador then supplied the court with mounting evidence that Kaczynski’s refusal to be evaluated related to anosognosia, a manifestation of Kaczynski’s schizophrenia.

That one of Kaczynski’s three main symptoms of schizophrenia was his detailed and carefully documented denial of having it and resistance to being labelled doesn’t appear to strike Amador as funny. I might add that Kaczynski’s other main symptom — “delusional” worries about the all-important role technology seems to play in our society and the isolating effects that understandably follow — has troubled me, and hundreds of thousands of others, from time to time. Does that make us all sick?

I guess it does if they say it does!

The article goes on to share some of Amador’s initial inspiration to coin and then promote the term “anosognosia:”

It was his experience as a clinician and as a brother of someone with schizophrenia, Amador said, that led him to do research on anosognosia, “which is not to be confused with denial,” he emphasized, although in the beginning, he did not make that distinction. “That’s what I called it when my brother refused to take his medications, and that is what I called it when after his third hospitalization, I found his Haldol in the trashcan,” said Amador.

I suppose there’s no other possible explanation for a thinking, feeling, decision-making, adult human being throwing his Haldol in the trash can.

From a made-up word to the DSM-V: Amador takes anosognosia to the next level

About a year ago, when the DSM-V Task Force was really going at it hot and heavy, Xavier Amador issued this appeal on the Internet:

Dear Friends,

…Right now, there is no proposal to measure insight in persons with schizophrenia or bipolar disorder much less require that clinicians diagnose a subtype (with or without insight or with or without anosognosia). Such a requirement will drastically change treatment plans and hospital discharge plans. If a doctor has to diagnosis a lack of awareness of illness, then s/he is ethically obligated to address this problem, this symptom, and the non-adherence to treatment it causes. Rather than simply send the person on their way with a prescription they will never fill. I hope you will comment on the website Dr. Torrey recommends below.

We don’t have much time as the deadline for public comments is less that one month away…

Best wishes,

Xavier Amador

[emphasis added]

Doctors will be obligated to ensure adherence to treatment plan… “psychiatrists who care”must make sure their patients take their meds (perhaps in the form of injection)…

Isn’t that the exact sales pitch Janssen is using for their long-acting injection of Risperdal?

If anosognosia is officially added as a “symptom” of schizophrenia in the DSM-V, it essentially would make prescribing long-acting anti-psychotic injections to folks who “don’t know they’re sick” an ethical obligation!

Sounds like Janssen, and any other pharmaceutical company that manufactures a “flowers-in-the-bloodstream” shot, is going to score. Big time.

It is estimated that at least 25% of doctors in the US are paid by drug companies to actively participate in marketing efforts – be it standing in front of a powerpoint, “authoring” a ghostwritten scholarly article, or “consulting” in some other way. That’s about 200,000 men and women that are informally on the payroll of big pharma.*

Pharma certainly does not disclose these payments to the pubic, and the receipients of this easy money only have to disclose their ties to pharma if an institution they’re working with requires them to do so – and typically there are no professional consequences or reprimands no matter how big the conflict of interest they disclose is (see the DSM-V Task Force as an excellent example). Also, specific dollar amounts are generally not required.

But the times they are a-changing! As The New York Times reported yesterday in this story, pharmaceutical and medical device companies will soon be legally bound to disclose payments made to doctors for research, consulting, speaking, travel, and entertainment. That means everything from a $10,000 speaking “honorarium” to a $10 Cuban sandwich.

Who must disclose

Any company that has even one product covered by Medicare or Medicaid.

What they must disclose

All payments to doctors that are not these companies’ official employees. Also, royalty payments to doctors, “grants” to teaching hospitals or research institutions, and the value in dollars of “free” branded products (Serqouel pens, for example), food or other “goodies.”

ALL of the disclosures will be published on a Web site that any member of the public can freely access. [You better believe I’ll be a frequent visitor!!]

When they must begin disclosing

Technically, this was supposed to happenby October 1, 2011. But we’re running on government time here. What they’re saying now is that the policy is open to public comment until February 17th, at which point Medicare officials will “deliberate,” and issue their final rules which will be legally binding.

If a company doesn’t disclose

There will be a $10,000 penalty for each failure to disclose. If it is a knowing failure to disclose [not sure how they’re going to establish that…], the penalty could be as much as $100,000.

This is the only weak point in this entire policy — no company can be fined more than $1 million in a single year. I know what you’re thinking… “$1 million; that’s a lot of money!! Nobody would risk losing that much.”

A lot of money to us… peanuts to them. A million dollars is only a tiny fraction of their profits. Fact is, they don’t mind paying billions of dollars in fines, because as Lon Schneider, off-label marketing researcher so nicely puts it:

There’s an unwritten business plan. They [pharmaceutical companies] are drivers that knowingly speed. If stopped, they pay the fine, and then they do it again.

Nevertheless, the new disclsoure policy is likely to put at least some kind of a damper on the uninhibited bribing of doctors that has been building to a slimy crescendo over the past decade or so.

Hell — in a couple of years, the APA or FDA** might even be able to put together some kind of advisory committee of doctors unencumbered by severe financial conflicts of interest, possibly even capable of making unbiased, ethical decisions!

"Oh, is THAT what we're supposed to be doing? I'm really just here for the Cuban sandwiches."

* As of 2007, according to this article. Also plenty of examples in there of the whole we-pay-you-$500/hr-to-stand-in-front-of-our-powerpoint marketing scheme pharma is so fond of.

It’s not easy to balance a private medical practice, pharmaceutical company-sponsored lecture tours or research projects, and the invention of new psychiatric diagnoses… but at least 68% of the DSM-V Task Force is doing it! Yup; 68% of them openly report financial ties to the pharmaceutical industry (that’s up from the last time around, when 56% of the DSM-IV Task Force reported financial ties to pharma).*

That's pretty greasy...

It’s the Conflict of Interest Championships!

The DSM-V task force is divided into 13 work groups: ADHD, Anxiety, Child-Adolescence, Eating, Mood, Neurocognitive, Neurodevelopmental, Personality, Psychosis, Sexual-GID, Sleep-Wake, Somatic Distress, and Substance-Related. [They’re wild about hyphens over at the APA…] Each task force has 8-12 members, and each one of those members is required to disclose all ties to industry, professional organizations, and any other conflicts of interest [COI].

So here’s a fun game: go to the APA’s “Meet the Work Groups” web page, pick your favorite task force, and do a little investigating. How many members have financial ties to the pharmaceutical industry? And what kind of ties… is their research funded by pharma? Are they being paid for the use of their “expert opinion” in drug advertisements? Or is it an out-and-out bribe?

I’ve been playing the game all morning. Here’s the score:

Psychotic Disorders Work Group

4 of those 8 receive it in the form of what I like to call “free money” – they simply stand in front of a pharmaceutical company-designed powerpoint or give their name to a ghostwritten scholarly article, lending it an air of credibility, and win a cash prize! It’s called “honoraria,” “consultation,” or sometimes just “other” in the COI disclosures published on the APA’s website.

Coincidentally [or not], the makers of the 5 most commonly prescribed atypical antipsychotic medications** — in order… Astra-Zeneca (Seroquel), Janssen-Cilag (Risperdal),Bristol-Myers Squibb (Abilify), Lilly (Zyprexa), Pfizer (Geodon) — have ALL sponsored one or more members of the Psychotic Disorders Work Group.

Again, this strange coincidence: The makers of the 5 most commonly prescribed antidepressants – in order… Zoloft (Pfizer), Prozac (Lilly), Cymbalta (Lilly), Effexor (Pfizer), and Wellbutrin (GlaxoSmithKline) – are all contributing to the various bank accounts of our Mood Disorders Work Group workers.

Now you know what I’m going to say; the makers of drugs commonly prescribed to patients labeled in this category are well represented in those COI statements released by the Anxiety Disorders Work Group.

“But we thought the more hyphens and COI disclosures, the better!”

Sorry, APA. I don’t think you guys get it.

Let me make it real simple:

Hyphens for the sake of hyphens don’t make you look smart, and COI disclosures made with no fear of penalty or reprimand don’t make you look ethical.

The whole point of disclosing conflicts of interest is determining whether someone is unencumbered enough to participate in a decision-making/fact-finding process. So when Trisha Suppes says, “I have 46 financial ties to pharmaceutical companies, many of whom are trying to sell drugs to the people I’m trying to label,” … that should raise some red flags. She should not be included in the Mood Disorders Work Group, because she is clearly NOT capable of making unbiased contributions.

Indigestion…

With this level of greasiness going down, you guys are in for some serious indigestion. But, hey, don’t worry — there’s a pill for that!

*The figures for the DSM-V Task Force come from this article; for the DSM-IV, they come from here.

**As of 2009, according to this ranking. It appears to be the most recent ranking available. I’ve used it for all subsequent classes of drugs, as well.

It’s got research. Resources. Recovery stories. Best of all, the “Blogs” section showcases multiple writers, representing a wide spectrum of experiences and credentials… from “providers” and “consumers” to healers, advocates, researchers — and many of these folks sit at the crossroads of these different paths.

What unites them is Robert Whitaker’s literary message (as put forth most recently in Anatomy of an Epidemic): the (mal)practice of institutionalized psychiatry in America, and his more recent efforts to bring the message into the real world, to actively practice a solutions- and positivity-based response to the evils he outlines in his works.

LOVE IT!

I can really see this site growing into the preeminent online gathering place for alternative thinkers in mental health. Our community needs a home base, a place to process our experiences and articulate the many amazing ideas for reform and recovery we’ve all got cooking in our various noggins.

Look what I found…

I found this true gem buried in the comments section of a Michael Cornwall article entitled “Initiatory Madness” (a stark and moving depiction of his own dealings with madness and abrupt loss of innocence at the age of 20).

[We must understand] the necessity for our waiting on madness to continue its often pain-filled birthing process in the sanctuary of our heartfelt compassion. Our first impulse when a loved one is in intense emotional distress and pain is to give them anything to relieve their hellish pain. It appears grossly irresponsible, if not cruel, to withhold medicine that would quickly numb the emotional suffering of a person in the throes of madness. But what the paradoxical evidence shows, is that if …any young person in their initial experiences of madness is not allowed to go through their purposive madness in the requisite healing crucible of a heart center sanctuary, then a huge majority of us would be stuck, trapped in a laboring process that can go on our whole lives. Birthing is painful but it accomplishes its task of bringing new life forward. But being suspended in the birth canal indefinitely, emotionally numbed out of fear of the raw emotions of transformative, life-renewing madness, is a tragic waste of our birthright.

the parallel he draws between madness/the emergence of a new, awakened consciousness and labor/the emergence of a new human life

the fact that both of these experiences, in all their terrible power, are our birthright!

Labor is a (sometimes) painful opening. A birthing woman is truly exposed in a way she may never again be in her life. Emotions raw, body and mind experiencing something fundamentally new and perhaps even frightening, she needs support, comfort, and reassurance to pass through to the other side. But despite the difficulties, remember that labor is a natural process, one for which she is designed by nature. She was made to do this! And it is her right, as a woman, to do it in the way that she sees fit.

Now our modern, institutionalized, corporate medical structures would have us believe that birth is a medical emergency (perhaps even pathological!) requiring numerous invasive techniques and expensive procedures to deliver mother and baby from death’s door.

But here’s the thing… women have been giving birth at home, without doctors, for literally thousands of years! And the majority of women around the world are still doing it. And doing just fine. How did we survive so long without these “life-saving” doctors and their “miraculous” procedures?

We don’t need them. We are strong enough to do it with only the support and love of a few who care for us… and be the better for the experience! By coming that close to our spiritual origin and our mortality as well, we are people with a new, heightened knowledge of our humanity. We are people who know a deeper kind of love: visceral, unconditional, of the soul. And by doing it together, we share this experience with our loved ones, we build community, we further cement the bonds of humanity.

Michael is right on… all of the above applies to madness as well. In madness, we are opened to a new, deeper experience of reality. This can be terrifying, and we will probably need some serious support and love to get through it safely.

But we can do it! Without coercion, or unwanted chemical intervention. We wouldn’t have survived for thousands of years on this planet if we couldn’t.

In transition, the woman is fully dilated and the head (usually) of the baby must pass through the opening and into the birth canal. It is widely considered to be the most difficult part of giving birth. Luckily it is also the shortest; usually just 15 minutes or so.

At this point, almost universally, women have a psychological crisis. A mother previously handling birth well may go entirely to pieces. “I can’t do this,” many mothers at this stage of labor have said.

Labor support people (doulas, midwives, etc.) are trained to recognize and perhaps even warn the mother about transition. A mother who feels she can’t go on at this point may need nothing more than some strong encouragement from her supporters to move beyond the crisis.

Unfortunately, the purveyors of birth medications are also trained to recognize transition, and most women who had not planned on a medicated birth accept medication during this period (which is rather unfortunate, as the period is often over before the medication can take effect and the mother is subsequently numbed, unable to follow her body’s cues as her baby descends the birth canal).

Back to madness

I can’t help but think that the well-known crisis of faith in oneself at “transition” has some parallels in the experience of madness. If only professionals were trained to recognize the crisis (which sometimes takes a suicidal bent), and coach the person through it – seeing it as a phase of the process, rather than a medical emergency requiring immediate incapacitation – perhaps more people would be allowed to transition into later stages of their journey.

What Michael is saying is that many psychiatric patients are frozen (by medication) in early stages of their journey, never being allowed to follow their path. They are “laboring” their whole life long, their bodies and minds prohibited from opening, their souls unable to heal. A transition to wellness and rebirth never takes place.

Their birthing processes halted, their strength and resources untested, resolution and rest an impossibility—it is a senseless waste. And, in this consuming culture, I think we’ve all seen enough of senseless waste to last a lifetime.

Enough.

*Well, it may not be brand, spanking “new”… I have been out of the loop for a couple of months. But I’m happy to report I’ve gotten myself a little part-time office job, so I find myself suddenly blessed with plenty of free time for mental health blogging. Which means: ALT is back in the game!

** In 1998, the CDC reported that the US maternal death rate could be as much as three times higher than the officially reported number (which is bad enough!), because maternal death reporting is a.) not standardized and b.) optional. Every other developed nation has a standardized, mandatory, national system for counting maternal deaths and makes that data available to the public. For example, the UK issues one of these — a comprehensive report containing data on all maternal deaths that occurred during the period spanned by the journal — every 2 years.

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